These Things I See -- Like Millions of Eager Children
These Things I See -- Like Millions of Eager Children
Some memories happen in present tense...
Like millions of eager children and newly debt-laden parents, I wake well before sunrise on Christmas morning. I glance past the decorated tree my roommate has set up in the back of the apartment, through a floor-to-ceiling window that overlooks stark Georgetown treetops. Darkness, punctuated by street lamps, is sublime over the quiet city. I toast my bagel, change my shirt after spilling milk on myself, throw on a pair of gloves, and head out the door.
Washington, DC presents a cold morning, but there is no falling snow. I inhale deeply a couple of times and with my exhalations see my own breath. Then I get into my car and curse the air conditioning that will take 10 minutes to blow warm air. I'll be halfway to work by then.
We are on holiday schedule, so this marks my third day in 5 that I will arrive to the hospital and not leave until the next day. I manage a good mood, though, mostly because it would be audacious to allow myself self-pity in this setting. I sing on the way to work and my invisible passengers are polite not to complain. It helps to keep me warm.
The hospital is relatively hushed on Christmas morning. The census is the lowest of the year, less than one half the typical patient load. Children who remain are sufficiently sick that even relaxed discharge criteria have not sent them home. I find that my fellow intern, who is completing her overnight shift, is still sleeping when I arrive; I wake her by turning on the call room lights, eschewing my temptation to perform a loud, cackling, "Jingle Bells."
As I pre-round and examine my children, I find that a bag of wrapped presents has been placed at the foot of each child's bed. It is a consolation for those who are still here. Even the children who are too young to open gifts have been visited by St. Nick, leaving me to wonder if I should open them or let the nurses do it. Hey -- I love presents, too. I rip the paper from one and hand a rattle to a gabbling, googling 9-month-old whose wide eyes suggest an awareness of the day. She coos and smiles, wrinkling the tape on her cheek that holds the feeding tube in place.
Rounds go quickly, because there are few patients to discuss. I consider the double-edged irony: first, how serendipitous it is that children who typically stay for weeks on end become well enough to be discharged en masse around December 24th, and second, how illness is miraculously absent from children in Washington, DC around Christmas time so that the emergency room is desolate and new admissions are practically nil.
My fellow intern leaves the hospital shortly after rounds and goes home to spend Christmas with her family. She will return before dawn tomorrow, so I implore her to take it easy on the eggnog. Then I take to the task of daily chores and patient management that will continue into afternoon.
As lunchtime comes and passes, I recognize that the hospital is open for business only in name. Getting a diagnostic test, specialty consult, or certain radiographic exams will be near impossible. Status quo is the goal. Some parents bring presents to the hospital. I pass a throng of elves in the hallway who are parading behind a very real Santa Claus. I thank the volunteers personally for their time, especially the one who goes into a room and holds a baby that has no one else to hold him.
Midafternoon of a holiday day that is moving along pleasantly, a call comes from a nurse. There is a parent who is upset and wants to speak to the doctor immediately. He is very mad, she tells me. As I enter the room, he is aggressive with questions in a tone of voice that is distinctly antagonistic. I explain why discharge has been postponed a couple of hours, how we simply want to watch his daughter a bit longer to make sure she is well. I am worried I may come across as irritated, but soon he becomes quiet and listens. I gain confidence in my explanation. Merry Christmas, he says, as I leave the room 15 minutes after I entered it.
It is late afternoon and I have just returned to the floor from the resident's lounge, where I had looked out the window and wondered how cold it was outside. I dial the phone. A nurse has brought in her tap shoes and the tickity-tickity on the linoleum floor makes it difficult for me to hear the telephone radiology reports. One of the really cute babies, who happens to be so pleasantly plump notwithstanding a very bad case of reflux, sits in a nurse's arms behind the computer console and devours a bottle of thickened formula. Some babies are cuter than others, I tell myself.
The pace picks up a bit as evening falls, which is typical status post Christmas Day and Christmas presents, when Dad forgets a screw on the new trampoline or 6-month-old Johnny tastes, then inhales, the LEGO. A transfer is coming from the intensive care unit, and 3 admissions are waiting in the emergency room. The parents in Room 54 are concerned about their daughter's breathing rate. A chest x-ray I ordered yesterday has not been done. An IV falls out. The belligerent father from earlier in the day calls from home to ask a question about his daughter -- in a much nicer tone.
I take a moment amidst the scuttling activity to appreciate the subtle fact that I have come a long way in the 6 months I have been here.
Nighttime falls and I reheat my left over Chinese food. Things have slowed down. The skeleton crew of nighttime nurses is holding lonely babies and hoping out loud that the night is quiet because so-and-so called in sick. I announce that I am going to lie down -- be selective in your paging, I ask nicely -- and head for my call room. The bed is disheveled, as the cleaning crew must have been skeletal as well.
I take out a folded progress note and work on a rough draft for my MEDSCAPE article, hoping that I get some sleep and that the night is as kind as Christmas Day has been.
Some memories happen in present tense...
Like millions of eager children and newly debt-laden parents, I wake well before sunrise on Christmas morning. I glance past the decorated tree my roommate has set up in the back of the apartment, through a floor-to-ceiling window that overlooks stark Georgetown treetops. Darkness, punctuated by street lamps, is sublime over the quiet city. I toast my bagel, change my shirt after spilling milk on myself, throw on a pair of gloves, and head out the door.
Washington, DC presents a cold morning, but there is no falling snow. I inhale deeply a couple of times and with my exhalations see my own breath. Then I get into my car and curse the air conditioning that will take 10 minutes to blow warm air. I'll be halfway to work by then.
We are on holiday schedule, so this marks my third day in 5 that I will arrive to the hospital and not leave until the next day. I manage a good mood, though, mostly because it would be audacious to allow myself self-pity in this setting. I sing on the way to work and my invisible passengers are polite not to complain. It helps to keep me warm.
The hospital is relatively hushed on Christmas morning. The census is the lowest of the year, less than one half the typical patient load. Children who remain are sufficiently sick that even relaxed discharge criteria have not sent them home. I find that my fellow intern, who is completing her overnight shift, is still sleeping when I arrive; I wake her by turning on the call room lights, eschewing my temptation to perform a loud, cackling, "Jingle Bells."
As I pre-round and examine my children, I find that a bag of wrapped presents has been placed at the foot of each child's bed. It is a consolation for those who are still here. Even the children who are too young to open gifts have been visited by St. Nick, leaving me to wonder if I should open them or let the nurses do it. Hey -- I love presents, too. I rip the paper from one and hand a rattle to a gabbling, googling 9-month-old whose wide eyes suggest an awareness of the day. She coos and smiles, wrinkling the tape on her cheek that holds the feeding tube in place.
Rounds go quickly, because there are few patients to discuss. I consider the double-edged irony: first, how serendipitous it is that children who typically stay for weeks on end become well enough to be discharged en masse around December 24th, and second, how illness is miraculously absent from children in Washington, DC around Christmas time so that the emergency room is desolate and new admissions are practically nil.
My fellow intern leaves the hospital shortly after rounds and goes home to spend Christmas with her family. She will return before dawn tomorrow, so I implore her to take it easy on the eggnog. Then I take to the task of daily chores and patient management that will continue into afternoon.
As lunchtime comes and passes, I recognize that the hospital is open for business only in name. Getting a diagnostic test, specialty consult, or certain radiographic exams will be near impossible. Status quo is the goal. Some parents bring presents to the hospital. I pass a throng of elves in the hallway who are parading behind a very real Santa Claus. I thank the volunteers personally for their time, especially the one who goes into a room and holds a baby that has no one else to hold him.
Midafternoon of a holiday day that is moving along pleasantly, a call comes from a nurse. There is a parent who is upset and wants to speak to the doctor immediately. He is very mad, she tells me. As I enter the room, he is aggressive with questions in a tone of voice that is distinctly antagonistic. I explain why discharge has been postponed a couple of hours, how we simply want to watch his daughter a bit longer to make sure she is well. I am worried I may come across as irritated, but soon he becomes quiet and listens. I gain confidence in my explanation. Merry Christmas, he says, as I leave the room 15 minutes after I entered it.
It is late afternoon and I have just returned to the floor from the resident's lounge, where I had looked out the window and wondered how cold it was outside. I dial the phone. A nurse has brought in her tap shoes and the tickity-tickity on the linoleum floor makes it difficult for me to hear the telephone radiology reports. One of the really cute babies, who happens to be so pleasantly plump notwithstanding a very bad case of reflux, sits in a nurse's arms behind the computer console and devours a bottle of thickened formula. Some babies are cuter than others, I tell myself.
The pace picks up a bit as evening falls, which is typical status post Christmas Day and Christmas presents, when Dad forgets a screw on the new trampoline or 6-month-old Johnny tastes, then inhales, the LEGO. A transfer is coming from the intensive care unit, and 3 admissions are waiting in the emergency room. The parents in Room 54 are concerned about their daughter's breathing rate. A chest x-ray I ordered yesterday has not been done. An IV falls out. The belligerent father from earlier in the day calls from home to ask a question about his daughter -- in a much nicer tone.
I take a moment amidst the scuttling activity to appreciate the subtle fact that I have come a long way in the 6 months I have been here.
Nighttime falls and I reheat my left over Chinese food. Things have slowed down. The skeleton crew of nighttime nurses is holding lonely babies and hoping out loud that the night is quiet because so-and-so called in sick. I announce that I am going to lie down -- be selective in your paging, I ask nicely -- and head for my call room. The bed is disheveled, as the cleaning crew must have been skeletal as well.
I take out a folded progress note and work on a rough draft for my MEDSCAPE article, hoping that I get some sleep and that the night is as kind as Christmas Day has been.
